Efteruddannelse i Krisepsykologi. Psykotraumatologi: Historie, teori, praksis. Kursusdag 9. maj, 2007 med Anders Korsgaard.

Transkript

1 Efteruddannelse i Krisepsykologi. Psykotraumatologi: Historie, teori, praksis. Kursusdag 9. maj, 2007 med Anders Korsgaard.

2 Program for onsdag, 9. maj : Formiddag: Hvad er psykotraumatologi. Hjælper kriseterapi det eller er det sundhedsskadeligt? Hvad traumatiserer og hvorfor. Akutte reaktioner og psykologiske senfølger efter traumer. Eftermiddag: Oversigt over akutte og opfølgende behandlingsformer. Organisering. Den traumatiserede hjælper.

3 Historie: Vietnam-krig. Terror. PTSD og ASD diagnosen. Terror i Danmark Ulykker / katastrofer: Scandinavian Star, Estonia, Bali, Busulykke Knippelsbro,New York 9-11, Tsunami, December 2004, Libanon 2006

4 Krisepsykologisk Enhed, Siden RH: Kriseterapi i forbindelse med traumer på jobbet ( vold, røveri, overværelse af andres traumatisering) Kriseterapi i forbindelse akut alvorlig sygdom ( fysiske traumer ) Beredskab ved større ulykker.

5 Acute stress disorder Definition : Acute Stress Disorder is a anxiety disorder that develops within one month after a severe traumatic event or experience. Distressing dissociative symptoms are common in the person with Acute Stress Disorder, including depersonalization, derealization, or dissociative amnesia. These symptoms can effect any sex or age group. Anxiety, irritability, and depression are also common in people who have Acute Stress Disorder. People with Acute Stress Disorder have a diminished ability to experience pleasure. There may be problems falling or staying asleep. A person with Acute Stress Disorder will avoid any reminders of the trauma but re-experiencing the event in dreams, nightmares, or painful memories.

6 ASD ONSET: COMMON: Any age, symptoms start during or immediately after trauma.

7 ASD: Three or more of the following dissociative symptoms that developed during or after the event or experience: 1. Loss of emotion, numbing, or detachment. 2. Diminished awareness of surroundings. 3. Depersonalization. 4. Derealization. 5. Dissociative amnesia.

8 ASD: The event or experience must be reexperienced in at least one of the following: 1. Distressing recollections of the event or experience. 2. Dreams that are reoccurring and distressful. 3. Reliving the event or experience in the form of flashbacks, hallucinations, images, illusions, or thoughts. 4. Reacting in a physiological manner to any aspect of the event or experience

9 ASD: Persistent indicators of increased arousal. ( E.g., Problems with falling or staying asleep, Having problems concentrating, Hypervigiland, Response to being startled is overstate. ) Must be impairment in important areas of functioning. (E.g., work, social life,... ) SYMPTOMS MUST LAST 2 DAYS TO 4 WEEKS. IF SYMPTOMS LONGER THEN 4 WEEKS SEE: POSTTRAUMATIC STRESS DISORDER ( PTSD. )

10 PTSD Definition : Posttraumatic Stress Disorder ( PTSD ) is a anxiety disorder that develops after a severe traumatic event or experience. Several distressing symptoms are common in the person with PTSD, including Psychic numbing, emotion anesthesia, increased arousal, or unwanted re-experiencing of the trauma. These symptoms can effect any sex or age group. Anxiety, irritability, and depression are also common in people who have PTSD. People with PTSD have a diminished ability to experience emotion, including tenderness or intimacy. There may be problems falling or staying asleep. A person with PTSD will avoid any reminders of the trauma but re-experiencing the event in dreams, nightmares, or painful memories are common. Some people will turn to drugs or alcohol to escape the pain of PTSD. While others may become suicidal or self-defeating.

11 PTSD: ONSET: COMMON: Any age, symptoms start within 3 months of trauma. LESS COMMON: Symptoms start after 3 months or years of trauma.

12 PTSD: Must have been exposed to a traumatic event or experience involving intense fear, horror, or helplessness. The event or experience must involve a threat of death, serious injury, or physical integrity. The event or experience may be to yourself or to others around you. A. The event or experience must be re-experienced in at least one of the following: 1. Distressing recollections of the event or experience that is both intrusive and reoccurring. 2. Dreams that are reoccurring and distressful. 3. Reliving the event or experience in the form of flashbacks, hallucinations, or illusions. 4. If exposed to any aspect of the event or experience a intense psychological distress followed. 5. Reacting in a physiological manner to any aspect of the event or experience

13 PTSD: B. Avoiding any thing associated with the trauma and a numbing of responsiveness. Indicated be at least three of the following: 1. Avoiding any thoughts or feelings about the trauma, including not wishing to engage in any conversation about the event or experience. 2. Avoidance of places, persons, or things that set off feelings about the trauma. 3. Can not recall import face about the event or experience. 4. A marked disinterest in significant activities. 5. Feelings of being detached or alienation from others. 6. Changes in range of affect. ( E.g., loss of loving feelings ) 7. Feelings of no real future.

14 PTSD: C. Persistent indicators of increased arousal, at least two of the following: 1. Problems with falling or staying asleep. 2. Irritability or outbursts of anger, sometimes unexpected and for no apparent reason. 3. Having problems concentrating. 4. Hypervigilant. 5. Response to being startled is overstate. A, B, and C must be for more then one month. Must be impairment in important areas of functioning. (E.g., work, social life,... )

15 PTSD: ACUTE: Symptoms less then three months long. CHRONIC: Symptoms longer then three months. WITH DELAYED ONSET: Onset of symptoms start six months after event or experience.

16 Hvad opnås ved debriefing?: Debriefing giver deltagerne mulighed for at dele deres belastende oplevelser med andre i et trygt og beskyttende miljø.

17 Der skabes forudsætninger for: Klargøring af fejlagtige opfattelser af hændelsen og dens konsekvenser - medvirker til at skabe et helt billede af hændelsen Genkendelse, accept og diskussion af følelser og stressreaktioner

18 Reduktion af symptomdannelse ( forebyggelse af PTSD, udbrændthed m.m.) Hvilke kollegaer har behov for yderligere hjælp. Styrkelse af deltagernes evne til at hjælpe hinanden

19 Orientering om muligheder for yderligere hjælp Styrkelse af team-spirit At man lærer på baggrund af hændelsen ( kan være til hjælp ved en senere hændelse der ligner)

20 Gruppen er handlekraftig igen i forhold til ny indsats

21 Behandling af post-traumatisk stress: Psykodynamisk orienteret behandling Fokal psykoanalytisk terapi ( Lindy) Kognitivt orienteret behandling. -social-kognitiv terapi. ( Janoff-Bulman) Eksistentielt orienteret behandling ( van Deurzen- Smith ) EMDR, TIR, CISM, Fysisk orienteret behandling. Biologisk / farmakologisk behandling.

22 Hvem skal have professionel hjælp?: Personlighedsfaktorer: Tidligere traumer, tidligere psykiske problemer, aktuelle livssituation Forebyggende faktorer: Træning og erfaring, social støtte. Faktorer ved den traumatiske hændelse: Hvad er der sket og hvordan har personen været involveret. Hvordan er hændelsen oplevet.

23 Forslag til litteratur: Dyregrov, Atle: Katastofepsykologi, van der Kolk, B., McFarlane, A. & Weisæth, L. eds.: Traumatic Stress. The effects of overwhelming experience on mind, body and society Horowitz, Mardi: Essential papers on Posttraumatic Stress Disorder, Foa, Edna et. al.: Effective treatments for PTSD, Journal of Traumatic Stress